“Could My Mother’s Acute Psychosis Be Linked to Hidden Schizophrenia? How Can I Help From Afar?”
#mentalhealth #psychosis #schizophrenia #familycaregiving
Have you ever wondered if acute psychosis could be a symptom of underlying schizophrenia? Learn about a reader’s personal experience and find out how you can support a loved one dealing with mental health issues from a distance.
Mother’s Recent Hospitalization
– ER visit due to acute psychosis
– Showing signs of auditory hallucinations
– Concerns about schizophrenia due to family history
Medical Evaluation and Concerns
– CAT scan done ruling out schizophrenia
– Doctor suspecting long-term build-up of symptoms
Previous Health Issues
– Painful condition possibly linked to trigeminal neuralgia
– History of alcoholism and migraines
Supporting From Afar
– Feeling powerless but still wanting to help
– Questions about mother’s self-awareness
– Limited contact due to hospital restrictions
Get insights into mental health challenges and learn how you can provide care and support to loved ones facing similar situations. Let’s build a community of understanding and compassion for those battling mental health issues.
Sorry this is happening. You don’t say your mom’s age, but it’s unusual to develop schizophrenia later in life. There are many other things that can cause auditory and visual hallucinations that aren’t schizophrenia, some of which are more likely than schizophrenia depending on her age, although having a sibling with it does increase her risk. Alcohol use disorder can predispose someone to certain types of brain dysfunction and dementia that could look like this, too.
It’s also worth noting that a CT scan cannot rule in or out schizophrenia. It’s hard to speculate further based on the information you have.
It’s highly unusual for someone first presenting schizophrenia so late in life. There’s something going on here, the CT scan will not exclude schizophrenia but it’s a valid investigation to exclude other causes. It’s worth pressing on to try to find a solid diagnosis.
Hello, I’m sorry about your mum. I’ll try to summarise and talk through a few things that could present like this. I’m not a soecialist but I have multiple rotations in Elderly Medicine, Elderly Inpatient Psychiatry, and acute Neurology. [But first of all a CT (CAT) cannot exclude a diagnosis of schizophrenia.]
So we have a year long history of facial pain (?trigeminal neuralgia ?migraines), tiredness, but also long periods of laying in bed. That last one is unusual. Depending on how severe this was it may be important (it could point to psychiatric condition building up or other chronic conditions).
The repetition you mention sounds like perseveration (a type of thought disorder) that can be present in schizophrenia but also in other causes of psychosis).
Finally we have an acute psychotic presentation with hallucinations. You have said these appear to be auditory but I would want to exclude visual as this is very important. These hallucinations appear to be people from her past. She appears to not be distressed or paranoid (I’m inferring).
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I’ll talk about a few causes then summarise at the bottom.
Schizophrenia is a psychiatric disease which includes the symptom that is psychosis. Psychosis can also be caused by a myriad list of other causes, these are termed Secondary Psychosis.
As the other two Physicians have pointed out Schizophrenia usually present earlier in life, that is before 40. Your mum may well be younger than we imagine, but if she is elderly schizophrenia is less likely (but not impossible, especially given her first degree relative has schizophrenia). Very Late Onset Schizophrenia (VLOS) is a known psychiatric condition that remains uncommon.
Another is right that schizophrenia is a diagnosis of exclusion. That is you exclude what I’m going to mention below.
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Other causes include certain types of Dementia, Strokes, Brain Injuries, Tumours, and Autoimmune encephalitis, Neuroinflammatory conditions, among others.
– I’ll not touch on brain injuries suffice to say that if she hasn’t had any head injuries we should be okay there.
– Strokes don’t usually present with psychosis but it is a surprisingly common secondary development in up to 1 in 20 stroke patients. This can follow a silent stroke (ie that presents with ‘milder’ symptoms) CT will usually show larger and older strokes but MRI is the gold standard in excluding Stroke.
– Tumours in the brain can occasionally present with psychosis (especially if in the frontal lobe) and CT cannot always exclude these. Usually a CT with contrast (ideally an MRI with contrast is needed). Her headaches and facial pain would not go against this possibility.
– Dementias, specifically Dementia with lewy bodies can have hallucinations (including visual) and many other symptoms including movement problems, disturbed sleep, fluctuating cognition. This is not seen on CT or MRI but on a special scan known as a DAT scan. Chronic alcohol use can lead to alcohol related dementias but this depends on the amount used and for how long.
– Autoimmune conditions are rare, they can also cause these types of presentations. They are myriad and complicated but when they effect the brain (autoimmune encephalitis or brainstem encephalitis) it can be acute or chronic with often a flu like presentation and headache, pain. Some signs of this may be seem on MRI but a Lumbar Puncture (spinal tap) is needed to properly investigate this.
– Neuroinflammatories including MS/Conditions related to neuromyelitis, brainstem inflammations, and other rarer ones need to be investigated by neurological review, MRI and lumbar puncture.
– Similarly viral or bacterial infections of the brain can present as above. Similarly these a lumbar puncture and are investigated alongside AI encephalitis.
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Okay so I have blathered a lot there and I’m not sure if it’ll be any help but essentially there are many causes, you should try to speak with the clinical team for an update on the process she has been through.
Ideally your mum would have a blood screen for various things. An examination for neurological signs would be invaluable. An MRI is extremely useful in looking for organic causes. A lumbar puncture with the right things tested can help rule out some of the other conditions I have mentioned above). A DAT scan would be useful if the full history and examination lends itself to DLB. If these are all negative the likelihood of a primary schizophrenia (or other psychiatric) condition rises.
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IMO I would want to exclude secondary causes, specifically neuroinflammatories, autoimmune encephalitis/DLB/other neurological conditions that can present like this before treating for a schizophrenia. This would include a neurology review, MRI, LP ++ only then would I be comfortable transferring her from an acute hospital to inpatient psychiatry.
All of this may have happened so trying to get clarity from your dad/the clinical team will be invaluable for you.
Apologies for the tome. Please take care of yourself. Please don’t feel guilty, there isn’t anything you can do but support your mum and family.
Also, Others please correct me if I’m wrong.